By Taylor Knopf

As indoor mask mandates drop in some of North Carolina’s most populous counties and schools, other non-COVID viruses are likely to start cropping up. 

We saw a similar trend in the summer of 2021. The U.S. saw a national spike in respiratory syncytial virus (RSV) as people got vaccinated and COVID restrictions loosened for a couple months before the onset of the Delta variant. RSV is a seasonal respiratory illness that usually spreads in the fall and winter, particularly among children who tend to have more severe cases of it.

Ibukun Christine Kalu, a pediatric infectious disease doctor at Duke. Photo courtesy of Duke Department of Pediatrics

Our patterns of behavior have been heavily altered by the pandemic and so have some trends in other common illnesses. Ibukun Kalu, a pediatric infectious disease doctor at Duke, said we typically expect to see a lot more RSV infections in January and February than what’s being reported this year. Instead, the virus peaked out of season.

COVID cases may be trending down at the moment, but other viruses and germs didn’t go away. We could start seeing more of the usual suspects — cold viruses and stomach bugs. Both have visited my house in recent weeks.

“As we mix a little bit more, we peel back masking, we travel a lot more, and we start to find ourselves in more crowded settings, I think we will see a different kind of spread of some of the other viruses that were a little bit lower in the last few years,” Kalu said. 

As I’m writing this, my son’s preschool emailed warning parents that an intestinal virus is circulating through the school. Unfortunately, I’m too familiar with that one as it ran its course through my family last week. Though my house has been vomit-free for a few days, my 2-year-old is in the other room sleeping off yet another non-COVID virus that’s given him a runny nose and a 102 degree fever.

Why it’s worse for toddlers 

Households with small children may be particularly susceptible to these non-COVID illnesses after two years of a pandemic. 

“It does raise a lot of concern for this age group, particularly our lovely 2 to 3 year olds that really have not been exposed to non-COVID viruses for a multitude of reasons the last two years,” Kalu said. “We may see those kids get routine infections for the first time.”

It’s normal for small children to catch a lot of different viruses during their first few years of life, “priming” their naive immune systems to get stronger. A reasonable exposure to germs and bacteria are actually good for the immune system. But if you’re like me and you kept your toddler at home, skipping holiday gatherings and birthday parties until now, your little one’s immune system might have some catching up to do.

My son was born about six months before the pandemic, and he didn’t even have the sniffles for the first two years of his life. His immune system went untested. This winter when the Omicron variant spread rapidly, his preschool closed out of caution for days, sometimes weeks at a time. While I and every other parent of a small child were losing our sanity juggling work and these sporadic child care closures, my son stayed healthy. 

Reporter Taylor Knopf’s son Theo takes the temperature of his stuffed elephant toy. Photo credit: Taylor Knopf

Since COVID cases started declining, my son’s preschool has been open and he has been congested, coughing, sneezing, vomiting or running fevers ever since. I’ve been checking in with his pediatrician, who says that this is all normal. I know his little immune system will be stronger for it, but it does feel like our household is experiencing a year’s worth of illnesses in a month’s time.

The good news, Kalu said, is that “the early immune system is extremely adaptable. It is so smart and learning from exposure and building defense systems. So it shouldn’t lead to any long-term negative outcomes for them. It just might mean a slightly rougher summer with some of these infections.” 

So fellow parents of little ones, here’s your warning: stock up on children’s Tylenol, Gatorade, tissues and Imodium (for yourself, because one of you will get the stomach flu too). And always contact your child’s pediatrician with questions. Your child’s doctor can also test for RSV or influenza and get them extra support if needed as these illnesses can be worse for small kids, Kalu said.

As you or your child battle these other illnesses, you should also monitor for COVID-19 if you’re experiencing flu-like symptoms to prevent further spread. 

“I think we should try and use tests as freely as possible, particularly for parents of toddlers who currently are not eligible for a vaccine,” Kalu advised. Rapid tests are very reliable when someone is showing symptoms. You can mail-order free government-funded rapid COVID tests to your home.

Don’t forget other vaccines

Spring usually means the tapering off of flu season. But this year could be different. If you haven’t gotten you or your child a flu shot yet, Kalu says it’s not too late to do so, especially if you’re planning gatherings and travel. 

She said that public health experts typically expect to see a decline of flu and other respiratory viruses in March, but that they could linger a few extra months this year.

As statewide COVID cases have steadily declined, influenza-like illness increased slightly in early March, according to the state health department’s surveillance system. Nationally, there have been more cases of the flu and related hospitalizations in recent weeks, and flu vaccination rates are lower than previous flu seasons. While current flu cases are higher than last season, they are not higher than pre-pandemic levels. 

Graph showing the percent of ED visits this season (red line) that are for influenza-like illness compared to previous seasons (grey lines). Recently, there’s been an uptick in the number of people reporting to North Carolina’s emergency departments complaining of flu-like illnesses. Data: NC DETECT; Graph courtesy: NC DHHS

“But the reassuring thing is we’ve handled these viruses for decades,” Kalu said. “We actually know what to do and perhaps we’ve learned a little bit more with a pandemic about how we can take better care of ourselves when we’re feeling ill to prevent spread.”

Parents should also make sure their children are up to date on their other vaccines, such as chickenpox or the MMR series which prevents measles, mumps and rubella. 

Rates in childhood vaccines took a hit during the pandemic as parents missed routine pediatric appointments. Researchers compared childhood vaccine data from 2020 and 2019 and found rates of vaccination significantly declined in 2020 across all age groups. Vaccine rates for Black babies were the lowest across all population groups, one study found.

The Centers for Disease Control and Prevention reported that vaccine ordering data show a 14 percent drop in 2020 and 2021 compared to 2019, and measles vaccine ordering is down by more than 20 percent. 

Public health experts say it’s important to get all children up to date on their vaccines to prevent any outbreaks of illness. The CDC has resources for parents and physicians about how to catch up. 

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Taylor Knopf

Taylor Knopf writes about mental health, including addiction and harm reduction. She lives in Raleigh and previously wrote for The News & Observer. Knopf has a bachelor's degree in sociology with a...